Barber - Sole Proprietor/Partnership Shop Owner Original License


Personal Information:

Enter business type: Sole Proprietor or Partnership

Sole Proprietor or
Partner #1 Name:
First Middle
Last
Partner #2 Name: First Middle
Last

The following personal information should be for the sole proprietor or partner #1:

I have a United States mailing address
Address:
City, State Zip: , -
County:
I have a mailing address outside the United States
Address:

Social Security Number:
Date of Birth (MM-DD-YYYY): - -
Place of Birth:
I was born in the United States
  City and State: ,
I was born outside the United States
  City and Country:
Gender:         Male Female
Home Phone Number: - -
E-mail Address:

Business Information:

Note: If you change the name of your shop, the outside signage of the business must be changed to match the shop's name. If the names do not match, you are in violation of the Barber Regulations.
Shop Name/Outside Signage:
Shop Address:
City, State Zip: , -
County of Shop Address:
Business Phone No.: - -

Required Information:

Has the applicant, sole proprietor or any of the partners:
1. Ever been convicted of a felony or misdemeanor in any State or Federal court? Yes No
2. Ever had this type of license denied, suspended, or revoked by Maryland or any other State? Yes No
3. Been convicted of or received probation before judgment of any drug offense committed after January 1,1991? Yes No

Workers Compensation:

 I have Workers Compensation Coverage   Policy/Binder No.

Issued by the  

 I am not an employer required to provide employee coverage under the Workers Compensation Law.


Certification:

By pressing "Submit" below:


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